Healthcare Provider Details

I. General information

NPI: 1235287889
Provider Name (Legal Business Name): AMANDA MARIE PLOSKI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIE STODD APN

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 SUMMIT ST
ELGIN IL
60120-3843
US

IV. Provider business mailing address

995 COMMONWEALTH CT
BARRINGTON IL
60010-3154
US

V. Phone/Fax

Practice location:
  • Phone: 847-608-1344
  • Fax: 847-841-6739
Mailing address:
  • Phone: 773-610-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209006377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: